MEDICARE: NORTHWEST DALLAS TX CAREGIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1215660154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST DALLAS TX CAREGIVING LLC

Provider Business Mailing Address
First Line	:	2612 WASHINGTON AVE STE 1
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76710-7469
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6370 LYNDON B JOHNSON FWY STE 278
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-6419
Country	:	US
Telephone Number	:	254-503-5233
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	MICHAEL HILLMAN
Credential	:
Telephone Number	:	800-410-2570

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	07/08/2022

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